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“We Can Have It All”

Or so says Dr. Donald Berwick, who is Obama’s Administrator of the Centers for Medicare and Medicaid Services (CMS).  He writes in an opinion article titled “We Can Have It All”: 

I am absolutely certain that we can have what we want and need-better care, better health and lower costs-all at the same time.

http://www.modernhealthcare.com/article/20110517/NEWS/305179959#ixzz1Obhb4c1Q

 

How can we achieve this nirvana of more care, better care, and less expensive care all at the same time?  Why, Government regulation, of course!  Dr. Berwick is the Administration’s primary proponent of ObamaCare, with all of it’s mandates, regulations, and taxpayer “investment” that they promise will lead to more efficient and effective delivery of services.  Let’s look at just one aspect, to evaluate the validity of their promise. 

The number one reason for mandates is to get coverage for all of those who are currently uninsured – with the highest rate being among young adults.  This is a significant and growing issue:

According to the 2010 Commonwealth Fund Biennial Health Insurance Survey, 45 percent of young adults age 18 to 26  surveyed are passing on needed medical care – a sharp increase from the 32 percent reported in 2001….  The report estimated there were more than 14.8 million uninsured young adults in 2009, an increase of nearly 4 million in 10 years. 

As a result, they aren’t filling prescriptions, going to the doctor when sick or seeing a specialist when necessary, and they’re not getting follow-up treatment recommended by a doctor.

http://www.healthcarefinancenews.com/news/young-adults-are-skipping-needed-medical-treatments-due-cost-report-says

 Again, the government response is more bureaucracy that they “promise” will be an improvement.  Specifically, the Patient Protection and Affordable Care Act (PPACA – better known as ObamaCare) addresses the problem by:  

  • Allowing young adults remain on or join their parents’ health plans up to age 26 (effective in 2010);
  • Requiring college health plans to meet new standards, starting in 2012;
  • Significantly expanding Medicaid eligibility to cover all adults with incomes below 133 percent of the federal poverty level (FPL) beginning in 2014; and
  • Creating new state health insurance exchanges with subsidized private insurance for people with low and moderate incomes up to 399 percent of the FPL, beginning in 2014.

 Now, put aside the fact that this younger demographic is more likely to be uninsured because they are also less at risk for needing expensive medical care.  Or the horrible job situation (made worse by Federal regulation, taxes and uncertainty hindering the economic recovery) that limits their ability to afford insurance.  And the fact that they have chosen to spend their money else where (like the rising costs of food and gas – but that’s another inter-related story).  If they have decided that these “needed healthcare” expenses because they had other priorities for their limited funds, then why should it become a demand on someone else to pay from their limited funds?  If your own care is not worth it to you, why is it worth it to someone else? 

Instead, let’s look at the Government’s solution that they “promise” will be an improvement.  Specifically, the Patient Protection and Affordable Care Act (PPACA – better known as ObamaCare).  Each of these features actually makes the problem worse, instead of better:

 

1) Allowing young adults remain on or join their parents’ health plans up to age 26 – So the Government solution to the problem of young people not wanting to pay for their own insurance, is to have their parents pay, instead.  Pass the buck, have someone else pay, and encourage extended dependency.  Note that parents could always pay for their child’s policy, if they so desired, but now it is explicitly encouraged by law.  Some will argue that adding a young adult to the parents’ policy is cheaper than purchasing a separate individual policy.  But the underlying medical care is the same price; in fact encouraging more coverage will increase the services demanded and therefore increase the costs of the total system overall.  And these increased costs will be passed on to parents. 

No solution, just cost shifting. 

2) Requiring college health plans to meet new standards, starting in 2012  – The issue of “mini-med” plans (cheap insurance with limited coverage and payment caps) has been highlighted by the rush to procure waivers to this regulation.  Requiring more expensive coverage is – you guessed it – more expensive.  And therefore unaffordable to many young people with limited means.  This same regulatory limitation becomes applicable to college health plans next year – driving up the costs of attending school, yet again.  The more expensive plans do provide more, but many with limited means would choose to spend their money on other priorities. 

A survey of 1,300 employers finds that 30 percent will “definitely or probably” stop offering health insurance to their employees due to new requirements imposed by the Obamacare health reform law.

http://cnsnews.cloud.clearpathhosting.com/news/article/30-percent-employers-drop-health-coverag

Reducing low-cost options will increase costs – not decrease them.  The problem is made worse.  

3) Significantly expanding Medicaid eligibility to cover all adults with incomes below 133 percent of the federal poverty level   – This is another case of cost-shifting; making Taxpayers pick up the tab.  There is no cost reduction, and in fact likely an increase in costs as young people decide to take advantage of the services at taxpayer expense.  The services that they decided were not worth it if they had to use their own money, suddenly becomes worth it when someone else is paying. 

Increasing services will increase costs.  The problem is made worse again.

4) Creating new state health insurance exchanges with subsidized private insurance  – The Federal Government is giving States “seed money” to set up insurance exchanges mandated by ObamaCare.  That up front cost is a net loss to taxpayers (if the exchanges were going to save so much, they would not require seed money to set it up – investors would seek that profit).  Then taxpayers will subsidize everyone up to nearly 4 times the poverty level – sticking the costs to the taxpayer again.  The fact that the poor are not paying their own costs makes them less sensitive to which plans they select from the Exchange system, and therefore drives up costs.  This is why government subsidized programs without built-in cost sensitivity to beneficiary selection will always cost more than expected, and continue to increase until they become unaffordable. 

Again, no solution, just cost shifting and the potential to make costs go up again.

This is a call to action, to maintain the pressure on all of our elected representatives to repeal this government overreach, under threat of voting them out. 

But CMS Administrator Dr. Donald Berwick says: “We can have it all”    Don’t you trust him?

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